# A case of hemobilia caused by a pseudoaneurysm resulting in obstructive cholangitis in a patient who underwent plastic stent placement for pancreatic cancer (with video)

## TL;DR

A rare case of hemobilia caused by a pseudoaneurysm led to obstructive cholangitis in a patient with pancreatic cancer who had a plastic stent placed.

## Contribution

This paper reports a rare case linking hemobilia to a pseudoaneurysm following plastic stent placement for pancreatic cancer.

## Key findings

- Hemobilia was identified as the cause of obstructive cholangitis during endoscopic stent replacement.
- A pseudoaneurysm of the posterior superior pancreaticoduodenal artery was successfully treated with coil embolization.
- The patient's cholangitis and hemobilia resolved without recurrence after treatment.

## Abstract

Hemobilia, or hemorrhage within the biliary system, is an uncommon cause of stent obstruction associated with bile duct strictures that are rarely observed with plastic stents. Reports of a pseudoaneurysm as a cause of hemobilia after plastic stent placement are also rare. We present a rare case of hemobilia caused by a pseudoaneurysm that resulted in obstructive cholangitis in a patient who underwent plastic stent placement for bile duct invasion caused by pancreatic cancer. A 78‐year‐old man with a history of stroke who was using antiplatelet therapy presented with obstructive jaundice caused by locally advanced pancreatic cancer and underwent endoscopic plastic stent placement in the bile duct followed by concurrent chemoradiotherapy. Second‐line chemotherapy was administered as the disease progressed; however, he experienced obstructive cholangitis and was admitted to our hospital. Hemobilia was identified as the underlying cause; notably, it was not evident during the initial evaluation and was diagnosed during endoscopic stent replacement. Emergency angiography revealed a pseudoaneurysm of the posterior superior pancreaticoduodenal artery, which was successfully treated using coil embolization. Cholangitis and hemobilia resolved, and the patient was discharged without bleeding recurrence.